Organizing institutions to support family and community care

One of my boys now likes to eat yogurt that is not stirred. This is a new “like”. So, it took me by surprise.

I learned about it one day when I did what I normally do when giving my young son his yogurt – I stirred it! Big mistake. He let me know in no uncertain terms. And later my wife filled me in on the finer points and how she’s been dealing with it. This new way (of liking) emerged while I was working in Singapore for a couple of weeks.

I admire my wife’s deep knowledge of our sons, and I am always struck by how much can change in a couple of weeks, or more to the point how many little things can change in that short time. I always feel a little sad at such moments; a pang of loss grabs hold of me.

Mostly though I am struck by the adaptability of my family and how we continue to find ways to love and care and deal with messy bits of our lives together. The yogurt was no big deal, me keeping up with the rhythm of our family life at home is. A central tenet of ABCD is that care is the freely given gift of the heart one person to another, and I firmly believe that both my wife and I care equally deeply for our children and each other. But care comes in particularities, it demands regular presence, and that’s our dilemma. My sons forgive me my need for catch-up periods, because they know I will work to catch up. But it’s a dilemma that needs negotiating in our house.

Our dilemma is a bit similar to that faced institutions I think. Particularly for professionals dealing with irregularity and distance from the context of normal living. While I draw a parallel, the difference of course between my family and an institution is profound, among many other distinctions, I am not a salaried stranger I am Dad. Still whether in a family or an institution, four possibilities present in the yogurt scenario with young children, and they develop from surface caring to deep caring:

1. The yogurt is given by the adult on their terms with no attention to the wants or likes of the child. The child may even be chastised for protesting.
2. The yogurt is given by the adult in a way the child dislikes, on the basis of a well intended assumption of how the child would like it, but the assumption is corrected by the child, and the next time the adult adapts. The interaction also acts as a good reminder to the adult of the importance of regularly checking in, because preferences change.
3. The yogurt is given to the child as they like it, because the adult is so in tune with the child’s likes and dislikes.
4. The yogurt is given to the child with a minimum amount of interruption by the adult and the child is supported to decide for example whether they want to stir, or not.

Ultimately we want the child to feel free to get his own yogurt; so I appreciate there are many other levels of depth after the four listed.

But the point I want to make here is that beyond a certain scale, and proximity a human being, regardless of how caring they are personally, will struggle to go deep and personal because the system will prevent them. Though struggle they should; that’s the deal with a caring vocation. However, it’s not that simple, the four levels of response suggested above offer a rudimentary test as to whether our ways of organizing institutional attempts at caring are forced into surface level impersonal responses or not. I am very struck by how often I hear services talking about surface level caring as though it were a good thing. Depersonalization and standardization of care is no care at all. By framing superficial programmes that lack particularity and knowledge of the person as though they are the high-water mark of equality, we create a form of counterfeit care; then conceal the act from public and professional oversight.

Recent responses to institutionalization around the world, especially in Europe, Oceania and North America have involved asking staff who work in human services institutions to alter their caring approaches to become more person-centred and less prescriptive. I know that approach works for me on my return home from work abroad, because of the small home scale context; because I’m Dad; and because I work a fair bit at home to nourish contact. But there’s the rub with person-centred care, it can’t simply be achieved by staff changing practice (though that will help), because the issue is largely the context. Therefore, change in human service institutions must also involve decommissioning services that have become too big; impersonal and congregated, and shifting the orientation back towards family and community.

An example of a service that did this is the Starfire Centre: https://www.starfirecincy.org in Cincinnati. Their mission is to:

Starfire is a groundbreaking organization working to build better lives for people with developmental disabilities, such as Down syndrome, autism, and cerebral palsy. We do this by increasing social connectivity through meaningful relationships and by working to remove barriers to opportunities in the community where people can be known for their gifts, not their disability.

Formerly a large daycare centre for people with intellectual disabilities, they have since decommissioned that service, and turned the centre towards the community and the local economy, in three distinct ways:

1. The majority of the centre’s space is now offered to the wider community as affordable work space filled by local entrepreneurs/small businesses;
2. The people who are served by Starfire are resourced with an annual budget to go do things they enjoy in their community, and that contributes to the wellbeing of their community. Thereby enabling them to connect as neighbours with gifts to offer and receive.
3. Staff of the centre have upcycled roles from what they would have previous done; they now journey alongside citizens who previously were at risk of not having their gifts recognised or received (due to labelling) to discover their gifts and find places of welcome in their community.

 

Just like my family face our own dilemmas, institutions and the people they serve, face theirs. But institutions don’t care, people do; when institutions organize like factories instead of families they stifle their people from caring. It is nice to know that at least some institutions are coming to understand the challenge before them: not just to make their institutions more person-centred, but also to support the people they serve to be interdependent at the centre of a natural and welcoming community.

Cormac Russell